APM Blog

Failed Back Surgery Syndrome

Failed Back Surgery Syndrome (1)

02 Nov

Back surgery doesn’t always mean the end of pain. In fact, a large portion of people still experience back and leg pain despite undergoing various types of spinal surgery, a condition universally called failed back surgery syndrome (FBSS). Fortunately, for those suffering from FBSS and for whom repeat surgery is not indicated – which is often the case – there are options to reduce the residual pain so sufferers can get back to a more normal quality of life.

Prevalence and Overview of FBSS

The true prevalence of FBSS isn’t entirely known, and estimates place the number anywhere between 5-50% of patients who undergo spinal surgery.[1] What is known is that the condition can come about from various types of surgeries and may be the result of removing bone (laminectomy or foraminotomy) or disc material (discectomy) or even a fusion of spinal segments.[2]

Failed back surgery syndrome doesn’t necessarily mean a failure on the part of the surgeon or that the pain is worse after surgery. FBSS simply refers to pain that persists after surgery – whether that pain is worse, unchanged or even slightly improved. In the case of FBSS, the outcome of the surgery just doesn’t meet the pre-surgical expectations of the provider and patient.[1]

Possible Causes

It’s thought that several factors can play into the development of FBSS.[2] Issues before surgery that can affect the outcome include spinal instability or anomalies in clinical images, in addition to preexisting conditions like diabetes, autoimmune disease and peripheral vascular disease.[3]

Psychological issues, like depression and anxiety, also play a role and patients with them are more likely to have unsatisfactory outcomes from surgery. [4]  Complications after surgery, like excessive inflammation leading to the development of fibrotic tissue, [2] can also result in unfavorable outcomes.

Treatment Options

Repeat spinal surgery is actually less likely to succeed than the primary surgery.[5]This means that oftentimes additional treatments provided by a pain management physician are needed to address the residual pain after spinal surgery.

Depending on the condition, pain management specialists have various options when it comes to managing FBSS pain. Oftentimes, they will utilize minimally invasive treatments such as epidural steroid injections, blocks or radiofrequency neuroablation. These, paired with physical therapy and other comprehensive treatments, can often lead to improved pain levels and overall quality of life.

Other times, physicians may turn to spinal cord stimulation, or SCS, a treatment that’s been proven more effective for FBSS than repeated surgery.[6] SCS delivers low voltage electricity to the spinal cord, interrupting pain signals before they reach the brain. With SCS, patients are able to try the system before permanent implantation and, once they receive the permanent version, are often able to reduce their reliance on opioids. Intrathecal pumps, which deliver medication directly to the spinal cord to block pain signals, may also be considered.

Preventing FBSS

However, as researchers note, preventing FBSS is much easier than treating it.[3] Preventing FBSS comes down, in large part, to proper patient selection for surgery,  meaning that for many, surgery may not be the right option. But for patients for whom spinal surgery is not indicated – or those who are hesitant to undergo such a serious surgery – there are other, less invasive treatment options. These may include some of the same options utilized to treat FBSS – like injections, blocks and radiofrequency – among others.

Learn More

If you’re looking for treatment options for FBSS – or are considering alternatives to spinal surgery – call (888) 901-PAIN (7246) to learn more today.

Download your free opioids and pain in-depth guide

[1] Taylor, Rod S., and Rebecca J. Taylor. “The Economic Impact of Failed Back Surgery Syndrome.” The British Journal of Pain 6, no. 4 (November 2012): 174-181.

[2] Russo, Marc. “Failed Back Surgery Syndrome: Pain That Persists after Surgery in a Subset of Patients.” International Neuromodulation Society. April 2002. Accessed August 30, 2016. http://www.neuromodulation.com/assets/documents/Fact_Sheets/fact_sheet_fbss.pdf

[3] El-Sissy, Mohamad H., Mohamad M. Abdin, and Amr M.S. Abdel-Meguid. “Failed Back Surgery Syndrome: Evaluation of 100 Cases.” The Medical Journal of Cairo University 78, no. 2 (March 2010): 137-144.

[4] Bordoni, Bruno, and Fabiola Marelli. “Failed Back Surgery Syndrome: Review and New Hypotheses.” Journal of Pain Research 2016, no. 9 (January 12, 2016): 17-22.

[5] Thomson, Simon. “Failed Back Surgery Syndrome – Definition, Epidemiology an Demographics.” British Journal of Pain 7 no. 1 (February 2013): 56-59.

[6] North, Richard B., David H. Kidd, Farrokh Farrokhi, and Steven A. Piantadosi. "Spinal Cord Stimulation versus Repeated Lumbosacral Spine Surgery for Chronic Pain: A Randomized, Controlled Trial." Neurosurgery 56, no. 1 (2005): 98-106.

Popular Posts

Categories